Person schema theory

Person schema theory (Horowitz, 2011, 2014) describes how parts of the self – images, bodily sensations, beliefs, values, defined roles, ways of being, identity concepts – come together to form organizing schemas that create a more or less cohesive and continuous sense of self or “me” and allow that self to navigate in the world. Levels of the model are nested in increasingly complex configurations of self-structures. Each level of organization involves conscious and unconscious elements. For example, at the most basic level of the model, parts of self, sensory experiences that pertain to the self may be encoded implicitly, making them inaccessible to a conscious elaboration of one’s experience but still allowing them to inform a sense of self and guide behavior. Self schemas link parts of self by collating different types of information formed in different types of memory (Horowitz, 1991, 1998; Kihlstrom, 1987; Piaget, 1962). The associational links of the self schema create a map containing cognitive-affective information based on past experience that forms the basis for generalizations about the self and self in relation to others (Baldwin, 1992; Bowlby 1969; Horowitz, 1991; Ryle, 1997; Stern, 1985; Young, Klosko, & Weishaar, 2003).

When internal or external stimuli activate a particular self schema, conscious and communicative expressions of self, or self-representations, arise and contribute to a conscious sense of identity. Conscious and unconscious components of self schemas inform self states, which reflect temporary, subjective experiences of self. Supra-ordinate self schemas connect individual self schemas but may or may not be connected themselves. Thus, while supra-ordinate self schemas represent higher, more complex levels of connectivity between any given grouping of self schemas, they may exhibit dissociation from another configuration of self schemas. Self-coherence refers to the individual’s ability to associate or segregate self schemas; it reflects the overall functioning of the self-organization described here.

It is important to note at this point that, according to person schema theory (Horowitz, 2011, 2014), all aspects of self develop and function within the context of relational matrices. Role relationship models (RRMs; Horowtiz, 2014) highlight this feature of the theory. RRMs, like internal working models (IWMs; Bowlby, 1969), are schemas that organize expectations for future interactions based on past experiences.¹ They incorporate information, including thoughts, feelings, and bodily sensations, about self and other within the relational context. When current interpersonal experience or the expectation of such primes an RRM, a configuration of relational expectations, self states, and self-representations becomes active. This can lead to recurrent patterns in relationships that engender distress and reify RRMs that do not accurately reflect important aspects of current realities. In this way, relationship patterns and the self schemas that are associated with them are learned in the past but may be maintained in the present (Horowitz, 2011, 2014; Levenson, 1995, 2003; Schacht, Binder, & Strupp, 1984; Wachtel, 1993). They may also be challenged in the present, opening the possibility of linking past, present, and future self schemas. Therapeutic interventions that facilitate trauma mastery aim to do just this within the context of a new relational experience.

Case example: a transient regression in sense of self and roles of attachment

The following vignette highlights how disturbances in a conscious sense of identity following trauma, such as diminished self-esteem, lapses in self-confidence, or depersonalization, reflect unconscious shifts in self-concepts that can be ameliorated as an aspect of trauma mastery (Aldwin, Sutton, & Lachman, 1996; Horowitz, 2011; Park, Cohen, & Murch, 1996).

While traveling on business in another country, Harold and his wife escaped a hotel fire, but experienced minor smoke inhalation injuries. Harold and his wife agreed that she would return home at once while Harold completed essential business appointments. Five days later, he began to feel tense and anxious, and had a sense of depersonalization. Harold became too talkative and attention-seeking from women he met with during his daily business dealings. One night he awakened from a nightmare and remembered himself screaming “Mommy, mommy!” He canceled meetings, immediately flew home, and sought professional consultation. On evaluation, he reported intrusive memories of the fire and of unbidden images of his wife leaving him at the airport. He was embarrassed in retrospect by his memories of seeking excessive closeness in his engagement with female colleagues. He feared travel and avoided planning future business appointments out of the city even though his financial future depended on it. He had states of tension, panic, and hyperventilation.

In the first phase of therapy attention focused on increasing his sense of safety and on the story of how the fire and its sequel led to an activation of latent self-concepts in which he needed attention and reinforcement of his goals and sense of values from a woman. The second phase of therapy focused on integrating this usually dormant role relationship model, of a dependent boy requiring maternal attention for guidance, and feeling abandoned without it, with his role relationship model as a competent person who interacted as an equal with a woman to whom he felt close. In other words, a helpful interpretation of his syndrome included the concept that his altered behavioral pattern after the fire occurred with activation of a usually dormant role, that of a dependent self looking for a secure attachment figure, rather than his usually active self-concept as an autonomous adult. In the third phase of a brief therapy attention focused on when he shifted between his competent versus incompetent self states, and how these were affected by emotional events in his relationship with his wife. Harold could recognize both self states as parts of his identity. He could also reflect on when each was activated and the conflict he experienced between them, which led to his embarrassment and shame. This work increased his sense of personal stability and enabled him to engage even more mutually with his wife than before the hotel fire.

The impact of trauma on the self

Transient regressions to earlier schemas of self are among the possible effects of trauma. Increased use of defensive dissociation, denial, and avoidance may also occur in an attempt to preserve pre-trauma schemas of self and other. These states may give way to or alternate with a sense of a fractured or disintegrating self marked by depersonalization, derealization, intrusive phenomena, or symptoms of hyperarousal (e.g., Herman, 1992; Horowitz, 2011). The interpersonal sequelae of trauma also contribute to the impact that trauma can have on the self. A person may be stigmatized or disrupted in relationships because of the inciting events. This can strip away external sources of validation by others and habitual environments, leading towards identity disturbances. As a result of trauma, persons may experience themselves as unattractive and contact with others may be avoided to protect against an expected rejection. In these ways, trauma can strain relationships and create conflict between new realities and old internalized RRMs. These disturbances in sense of self, self in relation to others, and identity may interact with and exacerbate posttraumatic symptoms such as intrusive memories, phobic avoidances, anxiety, and depression. They may also contribute to emotional under-regulation of angry or guilty moods and substance abuse.

As the examples above illustrate, trauma impacts the survivor’s entire world through its impact on self-organization. Self-organization mediates experience. Relative coherence of self-organization enables greater flexibility in dealing with new and unexpected cognitive-affective experience. Put another way, coherence of self-organization enables more realistic appraisal of self and others and more effective decision-making. Levels of integration of self–other schematization reflect coherence of self-organization and the abilities it supports. These levels are summarized in Table 11.1 (reproduced from table 6.1, p. 51, of Horowitz, 2014), where they range from the most coherent level, harmonious, to the most disorganized level, fragmented.²

When someone experiences a trauma, the severity of the trauma interacts with the individual’s level of personality integration resulting in a variety of responses to the traumatic stressor (Horowitz, 2014; see also Agabi & Wilson, 2005, for a review of the prevalence of the Person × Situation model of resilience and vulnerability to posttraumatic stress in trauma research). Recent research on the relationship between pathological narcissism, which might describe vulnerable levels of self–other schematization, and posttraumatic stress syndromes supports this theory. Using a multidimensional measure of narcissism, Bachar, Hadar, and Shalev (2005) found that narcissistic traits predicted PTSD status in Israeli civilians both one and four months after they were exposed to war trauma. Similarly, Besser, Zeigler-Hill, Pincus, and Neria (2013) reported positive associations between pathological narcissistic traits and symptoms of PTSD in Israeli civilians following exposure to war trauma. The findings of these studies suggest that the level of personality functioning reflected in pathological narcissism interacts with stress and can lead to syndrome development.

Reflective functioning and dissociation

Notably, the capacity to reflect on self increases as one moves from fragmented towards harmonious levels of functioning. Studies that have shown a correlation between maltreatment in childhood and deficits in reflective functioning and identity formation (Beegly & Cicchetti. 1994; Schneider-Rosen & Cicchetti, 1984, 1991, cited in Fonagy, Gergely, Jurist, & Target, 2004) highlight the way trauma can impact personality integration. Fonagy et al. (2004) also point out that deficits in mentalization, the ability and willingness to reflect on one’s own and others’ mental states,³ can contribute to survivors’ vulnerability to further abuse. The authors postulate that because those who show deficits in understanding mental states, such as abused children, seek physical proximity not stress-inducing mental proximity, they may move closer to their abusers (or abusive/neglecting others) while lacking the mentalizing skills that might help them accurately appraise danger and protect themselves. At the same time, deficits in mentalization and the comprehension of internal states that it facilitates can lead to externalization and projection of aggression, including the expectation of neglect/abandonment. Within this iteration of the model, re-enactments of traumatic experiences remain an attempt by an individual with impaired self-regulation and characteristic dissociative defenses to achieve regulation by turning a passive experience of trauma into an active experience of greater mastery and control.

The perspective presented here presupposes a multiplicity or a “committee of selves” (Horowitz, 2014, p. 23), which function optimally when the ability to access each other exists and is intact. This is not to say, however, that dissociation among self states is fundamentally maladaptive. To the contrary, dissociation is often needed to titrate overwhelming experience (Horowitz, 2014). It is also, as Bromberg (1998) has pointed out, essential as a means of heightening focus and preventing the stagnation of an overly determined self structure; dis-integration leads to growth when reorganization occurs as part of a re-integrating process (Horowitz, 2011, 2014). In these capacities, which arguably involve the capacity for mentalization, dissociation can enhance the self. However, following trauma, dissociation can also become a rigid defensive response to the threat of retraumatization and result in the siloing of self states, identity disturbances, and stress response syndromes (Bromberg, 1998; Horowitz, 2014). Rigid defenses developed in response to trauma affect the neurobiological systems that control perception, arousal, memory, emotion, and behavior; the effects on the self can be pervasive and lasting.

Neurobiological underpinnings of the impact of trauma on self

In his review of the research on the impact of trauma on neurobiological development, van der Kolk (2003) notes that because neurological systems mature and become functional at different times over the course of development, the impact of trauma differs by age. For example, the amygdala, which registers danger and triggers fear, is one of the first brain structures to begin functioning. However, the hippocampus, responsible for spatial and temporal localization of danger, develops over the course of the first five years of life and the prefrontal regions that enable a more sophisticated evaluation of danger and organization of response mature through early adulthood. Because early trauma affects hippocampal development, some scholars speculate that early trauma is more likely than later trauma to create a neurobiological system that is highly susceptible to misinterpreting stimuli as dangerous and less able to respond with effective self-protective behavious (Nadel, 1992, cited in van der Kolk, 2003).

Chronic trauma can extend and compact the impact of early trauma on neurobiology. Van der Kolk (2003) suggests that:

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The self in bipolar disorder The self in schema therapy Self processes in obsessive–compulsive disorder Painful incoherence: the self in borderline personality disorder Basic self disturbance in the schizophrenia spectrum: a review and future directions Future directions in examining the self in psychological disorders

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